Will Humble Disease Control, Prevention, Wills Blog

Arizona Sexually Transmitted Infection Action Plan in the Works

The Arizona Department of Health Services is developing a Sexually Transmitted Infections Action Plan as part of something state government calls a “Goal Council Action”.  I’m not 100% sure what a Goal Council exactly is, but an initial “STD Action Plan” was presented to and approved by the “Goal Council” last week.

The Plan includes numerous actionable interventions (below) – although there’s no recommendation to decriminalize syringe service programs- which is a key evidence-based best practice to reducing the spread of some sexually transmitted infections. Below are the action items in the elements in the Plan. 

  • Promote policies that allow providers to prescribe treatment for partners.

  • Improve access to screening and treatment in rural Arizona by implementing standing orders for chlamydia, gonorrhea, and syphilis.

  • Identify ways to encourage expectant mothers to access prenatal care and receive syphilis screening and promote healthy pregnancies.

  • Utilize perinatal caseworkers to better understand the barriers to accessing care and link women to prenatal care and other social services to prevent reinfection and promote healthy pregnancies.

  • Expand partnerships with correctional facilities, home visiting programs, and groups that work with current and recovering drug users to address root causes of STD transmission.

  • On-board additional laboratories to electronic laboratory reporting via HL7 messaging or spreadsheet reporting. Initiate the enhancement of ADHS IT infrastructure to accept electronic case reports (eCR) from providers.

  • Expand multi-site resistance screening in Maricopa County.

  • Develop a plan to respond to emerging STDs like LGV and Chancroid.

The agency will be scheduling follow-up meetings with stakeholder subcommittees to discuss the action plan in more detail and establish next steps for implementation.

Will Humble HIV Prevention, Opioids, Prevention, Public Health Law, Wills Blog

The Network for Public Health Law Launches Harm Reduction Legal Project

Individuals and communities across the United States are struggling with an epidemic of drug-related harm. Many states, including Arizona are hindered by laws and policies that reflect an outdated, punitive-focused approach to drugs and individuals who use them Like the fact that syringe service programs in Arizona are still technically committing felonies.

the Network for Public Health Law has launched the Harm Reduction Legal Project to address the legal and policy barriers that impair the implementation of evidence-based harm reduction measures. 

The Harm Reduction Legal Project provides direct guidance  to address legal and policy barriers to the creation, operation, and scale-up of harm reduction policies and programs.

Entities and individuals requesting assistance in navigating the often extremely confusing maze of existing laws and regulations that hamper harm reduction initiatives will have access to subject matter experts who can provide research, legal analysis, and strategic guidance as well as referrals to other knowledgeable experts and leading institutions. 

The Harm Reduction Legal Project provides real-time support to help organizations to successfully operate within existing law and policy while providing information to advocates who seek to modify existing legal restrictions on harm reduction initiatives.

To learn more or inquire about assistance from the Harm Reduction Legal Project, contact [email protected] or visit networkforphl.org/harmreduction. 

Will Humble Health Insurance, Wills Blog

Some States Implementing Interventions to make Insulin more Affordable

Folks living with Type 1 diabetes and some people with Type 2 diabetes require daily insulin injections as part of their treatment. The cost of insulin per patient has nearly doubled in the last couple of years with an astonishing average annual cost of $5,700 per patient.

In fact, one in four individuals with diabetes (both those with and without health insurance) have said they have rationed or skipped taking insulin due to cost…  which can cause medical complications and be life-threatening.

The federal government hasn’t done much to make it more affordable.  They (FDA) did announced a new policies to increase competition in the insulin market, but that hasn’t done much. 

Some state legislatures have moved forward to make it more affordable.  For example, Colorado recently enacted H.B. 19-1216, which will cap the co-pay for a 30-day supply of insulin at $100 effective Jan. 1, 2020.

Oregon enacted SB 9 which will allow pharmacists to prescribe and dispense emergency refills of insulin to people with a previous prescription.

A New York bill, introduced this week would allow pharmacists to dispense emergency insulin and related supplies in a similar manner.

The Florida, Illinois, Michigan, New York, Pennsylvania, Rhode Island, and Wisconsin legislatures have introduced similar bills each of which would cap the out-of-pocket cost for a 30-day supply of insulin at $100 (none have yet been enacted as far as I can tell though).

Will Arizona be the next state to implement interventions to make insulin more affordable?

Will Humble Federal Budget, Public Health Law, Wills Blog

Federal Public Health Budget Progress (FY20)

Last week the Senate released the FY20 Labor, Health and Human Services, and Education appropriation bill.  The draft bill includes $178.3 billion discretionary funding, which is an approximate 1% increase over FY19.

Click here for the bill text, report language, and full summary.  document.  It’s unclear how Congress will proceed with funding the federal government when the fiscal year ends on Sept. 30. Given current tension among various members of Congress and the differences between the House and Senate Labor, Health and Human Services, and Education bills, a short-term continuing resolution through November or early December seems likely.

Below is a high-level summary of the Senate bill. The bill is just a proposal, and the differences between the House and Senate bills will need to be resolved in conference.

At first glance, it appears that most public health programs are level funded when compared to the previous year’s funding levels. Notable public health provisions include:

CDC

The total proposed funding level for CDC is $7.5 billion, an approximate $180.5 million increase from FY19. The funding includes:

  • $140 million in new funding to support first year activities associated with ending the HIV epidemic.

  • $10 million, or a $5 million increase, to address infectious disease and the opioid epidemic.

  • $5 million to better inform how Adverse Childhood Experiences increase the risk of future substance use disorders, suicide, mental health conditions, and other chronic illnesses.

  • $10 million for a suicide prevention initiative to utilize data and evaluation to inform efforts to prevent suicide, especially among vulnerable populations.

  • A $100 million increase in funding to continue global health security efforts to accelerate capacity to prevent, detect, and respond to infectious disease outbreaks.

  • Level funding for ASTHO priority programs, including the Public Health Emergency Preparedness cooperative agreement at $675 million and the Preventive Health and Health Services Block Grant at $160 million.

SAMHSA

  • $1.5 billion for the state opioid response grant, which is level with FY19 funding.

HRSA

  • $50 million base funding for community health centers to increase outreach, testing, care coordination, and HIV prevention services, including the use of PrEP in high-need counties and states.

  • $677 million for the Title V Maternal and Child Health Services Block Grant, which is level with FY19 funding.

  • $25 million for the HIV/AIDS Bureau Special Projects of National Significance Program. This program supports the development, evaluation, and dissemination of innovative models of HIV care to improve the retention and health outcomes of Ryan White HIV/AIDS Program clients.

Office of the Assistant Secretary for Preparedness and Response

  • $11 million for the National Ebola Training and Education Center.

  • $275.5 million for the Hospital Preparedness Program. (Note: It is unclear from the report language text if this is an increase or level funding with FY19.)

Will Humble Uncategorized, Wills Blog

AzPHA Members Voting on Updated Firearm Violence Prevention Resolution 

In 2018, AzPHA members approved 3 new Resolutions including one entitled Resolution to Prevent Firearm Violence in Schools. 

This year we are proposing an update of last year’s firearm violence resolution. The updated version is entitled Resolution to Preventing Firearm Violence in the Community and Schools.

Our AzPHA Public Health Policy Committee developed the updated Resolution. The Board of Directors reviewed the Resolution at their September 20 meeting and have asked me facilitate an electronic vote of our members.

Accordingly, please review the updated Resolution and cast your vote at this link by close of business on Friday, October 4, 2019. We will announce the results in an October Public Health Policy Update and at the 2019 Annual Meeting on October 29, 2019.

Background about AzPHA Resolutions

Many of AzPHA’s  public health priorities are driven by Resolutions that are approved by our members.  AzPHA has dozens of Resolutions in place dating back to the 1930s.  They are all available on our Members Only site. 

Early resolutions focused on the importance of food safety regulations, tuberculosis control, family planning, and other contemporary public health issues.

More recent Resolutions have focused on support for addressing the Opioid epidemic, certifying community health workers, and addressing electronic cigarettes.  Our Resolutions are important to us because they set our public health advocacy priorities.

AzPHA Resolutions stay in place until and unless the Members vote to remove or update a Resolution. There is a process for developing new Resolutions.  Resolutions are developed by AzPHA Members and are forwarded to the Board for review. 

The Board reviews the Resolution and votes whether to forward the Resolution to the Members for approval.  Proposed Resolutions can be voted on electronically before the Annual Meeting or they can be voted on in-person at the Annual Meeting.  After approval of the resolutions, final copies are posted on the members only portion of our website

Will Humble Maternal Health, Prevention, Wills Blog

Arizona’s Efforts to Reduce Maternal Mortality and Severe Maternal Morbidity

By Mary Ellen Cunningham, AzPHA Board President

The United States ranks lower than Poland, Belarus and UAE among other nations in maternal mortality according to the CIA’s World Factbook.  A report from ACOG on maternal mortality tells us that the US Maternal Mortality rate is the only one raising among industrialized nations.  But deaths are the tip of the iceberg; it is estimated that 50-100 women experience severe maternal morbidity for every death. The CDC defines severe maternal morbidity as the unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman’s health.  So, what is killing or injuring Arizona mothers?  A report published by ADHS based on available data shows us the leading causes of death or severe injury are cardiac and hypertensive disorders, hemorrhage and suicide/homicide and accidents.

In the past few years, there have been efforts nationally and within Arizona to change that trajectory.  Arizona has had a Maternal Mortality Review process, which was actually just a few lines added to the statute for Child Fatality Review, since 2011 which created a subcommittee to look into Arizona maternal deaths.  While many volunteers reviewed the cases monthly, there were no reporting requirements and never any funding attached. Additionally, the state agencies are often handicapped by the inability to hire new folks.

But all that is changing…very much for the better.  For over a year now, the Bureau of Women’s and Children’s Health, in partnership with the March of Dimes and the Arizona Perinatal Trust has been leading Arizona’s efforts to reduce maternal fatalities and severe morbidities through a collaborative process. A Severe Maternal Morbidity/Maternal Mortality Prevention Taskforce was formed on October 30, 2018 and engaged over 36 stakeholders representing the state agencies, tribes, maternal health experts, and healthcare systems.

The Task Force met a few times during the past year, reviewed data and participated in facilitated discussions.  ADHS developed a Maternal Mortality Action Plan based on the suggested strategies:

  • Sustained partnership with the Alliance for Innovation on Maternal Health (AIM)

  • Engage providers and patients

  • Secure funding

  • Expand the scope of data analysis with respect to racial disparities

  • Continuous communication with stakeholders

The Task Force is ongoing.  Information about it can be found here.

The March of Dimes, at the same time, led the effort to expand on the work of the existing Maternal Mortality Review process.  As a result of the hard work of many, and led by Senator Kate Brophy McGee, SB1040 was passed and signed by the governor at the end of the 2019 Legislative session.  SB1040 requires ADHS to gather together an advisory committee to look at the maternal mortality and morbidity review process and to report on that review to the chairs of the House and Senate Health committees by December 31, 2019 and to have a report to the governor on the incidence and cause of maternal fatalities and morbidity by December 31, 2020.

In the meanwhile, there was no grass growing under ADHS. They had applied for and were awarded a competitive grant from the CDC to support the maternal mortality efforts by standardizing the current maternal mortality review process; supporting the MMRC in developing actionable recommendations;  disseminating the findings of the MMRC to different audiences and leading and supporting the adoption of maternity safety bundles at birthing facilities.  This $450,000 a year for five years will also support needed staff. 

They also applied to become a part of the Alliance for Innovation on Maternal Health (AIM), a national effort of reducing maternal mortality and severe maternal morbidity and have started working with AIM and at the same time are awaiting to hear about an additional grant application to HRSA about maternal health.

The members of the legislatively required Advisory Committee on Maternal Mortality and Morbidity were selected from an open application process and has met once and will meet again this Monday, September 16 to continue its work. There is a very short window to accomplish much.  I was selected to represent ‘a public health organization.’ It is an Open Meeting, so anyone is welcome to attend. Here is a link to the details.

Finally, maternal mortality has become a focus of the governor’s Goal Council.  ADHS is finishing up a plan that incorporates the work and the recommendations of the multipartnered Task Force.  This Plan should be out soon.  It will not only address the acute side of maternal mortality like hemorrhage or hypertensive crisis but will address many of the social determinants of health like access to care.  As public health folk know, its what happens upstream that changes societies.

On a personal note, I have never felt so hopeful for mothers and babies in this state.  ADHS, the March of Dimes, the Arizona Perinatal Trust and countless medical personnel and health care systems both public and private have all worked tirelessly for generations to improve the outcomes for mothers and babies, but this coordinated effort is beyond anything any one group could accomplish. There is a golden opportunity right now with a mix of state and national efforts, political will and ample funding.  The battle is ours to win.  

Will Humble Family Planning, Wills Blog

Providers Withdrawing from the Title X Family Planning Program

Earlier this year, the U.S. Department of Health and Human Services issued a final rule that would restrict federal funds for any Title X-funded clinic that performs abortions. Title X grants provide funding to community health centers and family planning clinics, such as Planned Parenthood health centers, to support health care service delivery for more than 4 million Americans, including low-income and uninsured individuals.

This new policy, often referred to as a “domestic gag rule,” would cut off Title X funds for health providers and facilities that give referrals for or provide abortions.

After numerous legal challenges by state and advocacy groups, the US 9th Circuit Court of Appeals allowed the rule to take effect in July 2019. On Aug. 9, HHS informed Title X family planning providers that they had until Aug. 19 to provide a plan to comply with the new rule or they would be forced out of the program.

On Aug. 19, Planned Parenthood (including their Arizona organization) announced that they would be pulling out of the program because of the new policy changes.  It remains to be seen what the network will look like in the coming months.  For sure, patients seeking family planing services will need to change their provider patterns.

Will Humble Immigration Policy, Social Determinants, Wills Blog

“Pubic Charge” Town Hall Set for Monday September 16th 

The new federal “public charge” rule is set to go into effect on October 15 of this year.  Here’s a link to my blog from a couple of weeks ago  that dives into what the new rule is and what it can mean from a public health perspective.

There’s confusion within the community regarding the rule, including which programs are included, who is affected and who is exempt from the public charge test.  Several Arizona organizations are putting on a town hall event to help answer those questions. 

It’s on Monday, September 16th at 6pm at the Encanto Elementary School Cafeteria.  It’ll  include a panel discussion to inform attendees about the new rule and immigration attorneys will be on site to answer individual questions.  

Here’s the Town Hall Flyer in English and  Spanish.   For those of you outside the Phoenix metro area, please note that the coalition is looking into hosting similar events in Tucson and Yuma.

Here’s the event on Facebook and a social media toolkit for the Public Charge issue.  Also, here’s a  Factsheet in English and Spanish.

Will Humble Firearm Safety, Injury Prevention, Wills Blog

AzPHA Public Health Policy Committee Revising our Firearm Violence Resolution

Our AzPHA Policy Committee has been hard at work updating our existing Resolution on firearm injuries and deaths to prepare for the upcoming legislative session. 

From 2009 through 2013, Arizona had more than 5,500 suicides, 2,000 homicides and another almost 900 undetermined deaths- needless to say these deaths represent a tremendous public health challenge in Arizona. 

The social costs to the community and the overall quality of life for Arizona residents are adversely impacted by homicides and suicides in our communities. 

Among the resources that the team is using are the compilation of research papers and analytic essays on public health and firearms on the APHA website.  Firearm research is available now available to everybody (including non-members) regarding the effect of state legislation on firearm homicide, interventions to improve safe firearm storage, employer firearm policies and workplace homicide, public opinion on carry laws.

Also included is research on role firearms play in establishing homicide as a leading cause of death for pregnant and postpartum women, the urban-rural differences in firearm suicides, how law enforcement and firearm retailers can serve as partners in suicide prevention, loaded handgun carrying, the financial cost of firearm injury, among other subjects.

Violent death surveillance data are available from the CDC and their National Violent Death Reporting System (NVDRS), which provides data to better understand violent deaths and to guide local decisions about efforts to prevent violence and track progress over time (the NVDRS is the only state-based reporting system that pools data on violent deaths from multiple sources into a usable, anonymous database).

The extensive data abstraction process collects information covering all settings, age groups and circumstances of violent deaths. The system gathers and collates information on violent deaths from: 1) State health department official death certificate data; 2) Medical Examiner reports at autopsy; and 3) Law enforcement investigation reports.

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